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Focuses on the effect of governmental control on drug safety and the process of drug regulation in the United States. Role of Food and Drug Administrations on the introduction of drugs; Background of drug regulation; Impact of the legislation on the drug industries.

The article reports on the changes in academic staffing in 24 university departments of pediatrics where undergraduates are taught in various regions of the U.S. Although there has only been a 7.2% decline in academic staff, among lecturers there has been a 26% reduction. In an accompanying perspective, a Professor urges young pediatricians to participate in established research networks. A Division Director for a group of 18 faculty and fellows who conduct clinical and health services research, and more recently as Vice Chair of Academic Affairs.

This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 year(1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact ¼ effectiveness 3 reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate. [ABSTRACT FROM AUTHOR]

Objective To integrate information on cigarette companies' understanding and use of menthol as summarised in published research based on previously internal tobacco industry documents with results from large population-based surveys of tobacco use and other independent sources. Data sources Papers published in this supplement of Tobacco Control, together with papers identified using PubMed searches. Results Tobacco companies shaped consumer perceptions of menthol cigarettes. Menthol is not just a flavouring agent. Cigarette companies use menthol's ability to mask irritation and provide sensory effects to make menthol cigarettes appeal to youth and healthconcerned smokers, in part because menthol makes low-tar cigarettes more palatable. Consistent with targeted marketing, youths, women and African Americans disproportionately smoke menthols. There appear to be complex interactions with addictive effects of nicotine. The ubiquitous addition of menthol by tobacco companies to over 90% of all tobacco products, whether labelled 'menthol' or not, demonstrates that menthol is not simply a flavour or brand. Menthol imparts sensory characteristics to cigarettes and has a complex interaction with nicotine that affects smoking behaviour whether it is perceived or not, or whether cigarettes containing menthol are marketed as 'menthol' or not. Adding menthol increases fine particles in cigarette smoke, which have immediate adverse effects on the risk of heart attack. Conclusion Information from industry documents, confirmed by independent scientific literature, consistently demonstrates that menthol increases population harm from smoking by increasing initiation and reducing cessation in some groups. Menthol facilitates and increases smoking, which causes disease and death. [ABSTRACT FROM AUTHOR]

Introduction: The use of human samples in genomic research has increased ethical debate about informed consent (IC) requirements and the information that subjects should receive regarding the results of the research. However, there are no quantitative data regarding researchers' attitudes about these issues. Methods: We present the results of a survey of 104 US and 100 Spanish researchers who had published genomic epidemiology studies in 61 journals during 2006. Results: Researchers preferred a broader IC than the IC they had actually obtained in their published papers. US authors were more likely than their Spanish colleagues to support obtaining a broad IC, covering either any future research project or any projects related to a group of diseases (67.6% vs 43%; adjusted OR = 4.84, 95% CI, 2.32 to 10.12). A slight majority of researchers (55.8%) supported informing participants about individual genomic results only if the reliability and clinical validity of the information had been established. Men were more likely than women to believe that patients should be informed of research results even if these conditions were not met (adjusted OR = 2.89, 95% CI = 1.46 to 5.72). Conclusions: This study provides evidence of a wide range of views among scientists regarding some controversial ethical issues related to genomic research, suggesting the need for more study, debate and education. In the interim, journals might consider including the investigators' policies regarding these ethical issues in the papers they publish in the field of genomic epidemiology. [ABSTRACT FROM AUTHOR]

Study objective: To examine the Canadian origins of the Lalonde Report and its impact on British and American health promotion activities. Design: A brief history of the development of key Canadian documents and their use by politicians and public health activists in the United Kingdom and United States. Setting: This paper focuses on the impact of the Canadian model on Canada, the United Kingdom and United States. Main results: This paper argues that internal political and economic forces are as important as international trends in determining healthcare policy initiatives. Conclusions: In the 1970s all the English-speaking developed nations were facing deficits as curative costs rose. Adopting health promotion policies permitted them to shift responsibility back to local governments and individuals while limiting their expenditures. Health and community activists, however, used this concept to broaden their focus to include the social, economic and political determinants of health and thus reinvented public health discourse and practice for the 21st century. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this paper is to investigate the relation between state and local government expenditures on public services and all cause mortality in 48 US states in 1987, and determine if the relation between income inequality and mortality is conditioned on levels of public services available in these jurisdictions. Methods: Per capita public expenditures and a needs adjusted index of public services were examined for their association with age and sex specific mortality rates. OLS regression models estimated the contribution of public services to mortality, controlling for median income and income inequality. Results: Total per capita expenditures on public services were significantly associated with all mortality measures, as were expenditures for primary and secondary education, higher education, and environment and housing. A hypothetical increase of $100 per capita spent on higher education, for example, was associated with 65.6 fewer deaths per 100 000 for working age men (p<0.01). The positive relation between income inequality and mortality was partly attenuated by controls for public services. Discussion: Public service expenditures by state and local governments (especially for education) are strongly related to all cause mortality. Only part of the relation between income inequality and mortality may be attributable to public service levels. Introduction: The objective of this paper is to investigate the relation between state and local government expenditures on public services and all cause mortality in 48 US states in 1987, and determine if the relation between income inequality and mortality is conditioned on levels of public services available in these jurisdictions. Methods: Per capita public expenditures and a needs adjusted index of public services were examined for their association with age and sex specific mortality rates. OLS regression models estimated the contribution of public services to mortality, controlling for median income and income inequality. Results: Total per capita expenditures on public services were significantly associated with all mortality measures, as were expenditures for primary and secondary education, higher education, and environment and housing. A hypothetical increase of $100 per capita spent on higher education, for example, was associated with 65.6 fewer deaths per 100 000 for working age men (p<0.01). The positive relation between income inequality and mortality was partly attenuated by controls for public services. Discussion: Public service expenditures by state and local governments (especially for education) are strongly related to all cause mortality. Only part of the relation between income inequality and mortality may be attributable to public service levels. [ABSTRACT FROM AUTHOR]

This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466-8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates and exercises the notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of "moral particularism" by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners. [ABSTRACT FROM AUTHOR]

Background: More than 90% of the cigarettes sold worldwide have a filter. Nearly all filters consist of a rod of numerous (> 1 2 000) plastic-like cellulose acetate fibres. During high speed cigarette manufacturing procedures, fragments of cellulose acetate that form the mouthpiece of a filter rod become separated from the filter at the end face. The cut surface of the filter of nearly all cigarettes has these fragments. In smoking a cigarette in the usual manner, some of these fragments are released during puffing. In addition to the cellulose acetate fragments, carbon particles are released also from some cigarette brands that have a charcoal filter. Cigarettes with filters that release cellulose acetate or carbon particles during normal smoking conditions are defective. Objective: Specific goals were to review systematically the writings of tobacco companies to: (a) identify papers that would document the existence of defective filters; (b) characterise the extent of the defect; (c) establish when the defect became known; (d) determine whether the defect exists on cigarettes marketed currently; (e) assess the prevalence of the defect on cigarettes manufactured by different companies; (f) define whether the knowledge of the defect had been withheld by the tobacco company as confidential and not disclosed publicly; and (g) ascertain the feasibility of correcting or preventing the defect. Methods: Document searches utilised databases of the scientific literature, medical journals, chemical abstracts, US Patents, Tobacco Abstracts, papers presented at tobacco meetings and court documents. Results: Sixty one documents of Philip Morris, Inc were selected for study because they disclosed specifically the "fall-out" of cellulose acetate filter fibres and, for cigarettes with charcoal filters, carbon particles from cigarette filters. The term "fall-out" was defined in 1 985 laboratory protocols of Philip Morris, Inc. as "loose fibers (or particles) that are drawn out of the filter during puffing of the cigarette". As early as 1957, the health concern of inhaling cellulose acetate fibres released from cigarette filters was addressed by Philip Morris, Inc. A 1962 document reported the results of laboratory tests conducted by Phillip Morris, Inc that compared the "fall-out" of cellulose acetate fibres from the filters of their cigarettes (Marlboro) and cigarettes of their competitor (Liggett & Meyers). A 1997 overview by Phillip Morris of documents addressing the "fallout of carbon particles and cellulose acetate fibers from bIters" stated that they were "essentially routine reports" of cigarette filter assays, and referenced a "Filter Fallout" memo written in 1961 -more than 40 years ago. Most likely these tests are being conducted presently as illustrated by a 1999 report that details the revisions of the "fall-out" protocol of Phillip Morris, Inc and reports the results of tests that measured the discharge of cellulose acetate fibres and silica gel from beta cigarettes with a new type of filter. Our analysis of the "fall-out" tests results presented in the 61 "fall-out" documents showed that filter fibres and carbon particles were discharged from the filters of all types of cigarettes tested. These cigarette types (n = 130) included both coded cigarettes and popular brand name cigarettes. No publications were found in the scientific literature of the "fail-out" studies. Thus, the results of the "fall-out" studies are thought to have been withheld as confidential to Philip Morris, Inc. We have identified also other companies that have tested recently cigarettes for defective filters. In addition, our searches have shown that simple, expedient, and inexpensive technologies for decontaminating cigarette filters of loose cellulose acetate fibres and particles from the cut surface of the filter have been developed and described in 1997 and 1998 US patents. What is more important is that these patents also define methods for preventing or reducing the broken plastic-like fibres that arise during cigarette making. Many US patents (n = 607; 1957 to 2001) have been awarded for cigarette filters. Some of these inventions describe novel materials and unique filtration schemes that would eliminate or minimise the discharge of filter materials into mainstream smoke. Conclusions: We have shown that: (a) the filter of today's cigarette is defective; (b) Philip Morris, Inc has known of this filter defect for more than 40 years; (c) the existence of this filter defect has been confirmed by others in independent studies; (d) many methods exist to prevent and correct the filter defect, but have not been implemented; and (e) results of investigations substantiating defective filters have been concealed from the smoker and the health community. The tobacco industry has been negligent in not performing toxicological examinations and other studies to assess the human health risks associated with regularly ingesting and inhaling non-degradable, toxin coated cellulose acetate fragments and carbon microparticles and possibly other components that are released from conventional cigarette filters during normal smoking. The rationale for harm assessment is supported by the results of consumer surveys that have shown that the ingestion or inhalation of cigarette filter fibres are a health concern to nearly all smokers. [ABSTRACT FROM AUTHOR]

Objective This paper considers the evidence on whether outdoor secondhand smoke (SHS) is present in hospitality venues at high levels enough to potentially pose health risks, particularly among employees. Data sources Searches in PubMed and Web of Science included combinations of environmental tobacco smoke, secondhand smoke, or passive smoke AND outdoor, yielding 217 and 5,199 results, respectively through June, 2012. Study selection Sixteen studies were selected that reported measuring any outdoor SHS exposures ( particulate matter (PM) or other SHS indicators). Data extraction The SHS measurement methods were assessed for inclusion of extraneous variables that may affect levels or the corroboration of measurements with known standards. Data synthesis The magnitude of SHS exposure (PM2.5) depends on the number of smokers present, measurement proximity, outdoor enclosures, and wind. Annual excess PM2.5 exposure of full-time waitstaff at outdoor smoking environments could average 4.0 to 12.2 µg/m3 under variable smoking conditions. Conclusions Although highly transitory, outdoor SHS exposures could occasionally exceed annual ambient air quality exposure guidelines. Personal monitoring studies of waitstaff are warranted to corroborate these modeled estimates. [ABSTRACT FROM AUTHOR]

A recent controversy over the US National Science Advisory Board for Biosecurity's recommendation to censor two publications on genetically modified H5N1 avian influenza has generated concern over the threat to scientific freedom such censorship presents. In this paper, I argue that in the case of these studies, appeals to scientific freedom are not sufficient to motivate a rejection of censorship. I then use this conclusion to draw broader concerns about the ethic of dual-use research. [ABSTRACT FROM AUTHOR]

Smoke-free policies have been an important tobacco control intervention. As recently as 20 years ago, few communities required workplaces and hospitality venues to be smoke-free, but today approximately 11% of the world's population live in countries with laws that require these places to be smoke-free. This paper briefly summarises important milestones in the history of indoor smoke-free policies, the role of scientific research in facilitating their adoption, a framework for smoke-free policy evaluation and industry efforts to undermine regulations. At present, smoke-free policies centre on workplaces, restaurants and pubs. In addition, many jurisdictions are now beginning to implement policies in outdoor areas and in shared multi-unit housing settings. The future of smoke-free policy development depends on credible scientific data that documents the health risks of secondhand smoke exposure. Over the next 20 year smoke-free policies will very likely extend to outdoor and private areas, and changes in the types of tobacco products that are consumed may also have implications for the nature and scope of the smoke-free policies of the future. [ABSTRACT FROM AUTHOR]

Background Cigarette butt litter is a potential target of tobacco control. In addition to its toxicity and non-biodegradability, it can justify environmental regulation and policies that raise the price of tobacco and further denormalise its use. This paper examines how the tobacco industry has managed the cigarette butt litter issue and how the issue has been covered in the media. Methods We searched the Legacy Tobacco Documents Library () using a snowball strategy. We analysed data from approximately 700 documents, dated 1959-2006, using an interpretive approach. We also searched two newspaper databases, Lexis/Nexis and Newsbank, and found 406 relevant articles, dated 1982-2009 which we analysed quantitatively and qualitatively. Results The tobacco industry monitored and developed strategies for dealing with the cigarette litter issue because it affected the social acceptability of smoking, created the potential for alliances between tobacco control and environmental advocates, and created a target for regulation. The industry developed anti-litter programs with Keep America Beautiful (KAB) and similar organisations. Media coverage focused on industry-acceptable solutions, such as volunteer clean-ups and installation of ashtrays; stories that mentioned KAB were also more frequently positive towards the tobacco industry. Among alternative approaches, clean outdoor air (COA) laws received the most media attention. Conclusions Cigarette litter, like secondhand smoke, is the result of smoker behaviour and affects nonsmokers. The tobacco industry has tried and failed to mitigate the impact of cigarette litter. Tobacco control advocates should explore alliances with environmental groups and propose policy options that hold the industry accountable for cigarette waste. [ABSTRACT FROM AUTHOR]

The issues related to tobacco harm reduction continue to challenge the tobacco control research and policy communities. The potential for combusting tobacco products to reduce exposure and risk remains largely unknown, but this has not stopped manufacturers from offering such products making these claims. The role of oral tobacco products in a harm reduction regimen has also been a source of dialogue and debate. Within the last few years, major cigarette manufacturing companies have begun selling smokeless products for the first time, claiming to target current cigarette smokers. Other cigarette manufacturers are also offering smokeless products in markets around the world. The harm reduction debate has at times been divisive. There has been no unifying set of principles or goals articulated to guide tobacco control efforts. In particular, the research needs are extraordinarily high in order to drive evidence-based policy in this area and avoid the mistakes made with "light" cigarettes. This paper discusses recommendations from a strategic dialogue held with key, mostly US-based tobacco control researchers and policy makers to develop a strategic vision and blueprint for research, policy and communications to reduce the harm from tobacco for the US. Short-term and long-term objectives are described. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This paper examines the prevalence of tobacco use among sexual minorities in the US through a systematic review of literature from 1987 to May 2007. METHODS: Seven databases were searched for peer-reviewed research (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library via Wiley InterScience, Education Resources Information Center (ERIC), Health Source: Nursing/Academic, Institute for Scientific Information (ISI) Web of Science, PsycINFO via EBSCO Host and PubMed). No language restrictions were used. Abstracts were identified in the literature search (n = 734) and were independently read and coded for inclusion or exclusion by two reviewers. When agreement was not reached, a third reviewer acted as arbitrator. Abstracts were included if they presented data collected in the US from 1987 to May 2007 and reported prevalence or correlation of tobacco use with sexual minority status. Studies reporting data from HIV-positive samples were excluded. The identified articles (n = 46) were independently read by two reviewers who recorded key outcome measures, including prevalence and/or odds ratios of tobacco use, sample size and domain of sexuality (identity, behaviour, or desire). Factors relating to study design and methodology were used to assess study quality according to nine criteria. RESULTS: In the 42 included studies, 119 measures of tobacco prevalence or association were reported. The available evidence points to disparities in smoking among sexual minorities that are significantly higher than among the general population. CONCLUSIONS: Ongoing, targeted interventions addressing smoking among sexual minorities are warranted in tobacco control programs. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the variety of ways that information about ethics-related methods are included or not included in public health research articles. Methods: Information about the ethics-related content of all articles published in nine highly-respected public health journals in 2006 was extracted. Results: Of 989 primary analyses, 73% of the articles commented on ethics committee approval or exemption, 63% mentioned participant consent and 9% indicated whether or not inducement or compensation was given. 84% of articles mentioned a funding source, but fewer than 4% identified any potential conflict of interest. Reporting rates for committee review and consent were higher for experimental than for observational studies and were comparatively higher in studies conducted among potentially vulnerable populations like children and residents of low income countries. Conclusions: More complete reporting would facilitate the design, evaluation and comparison of future research studies. [ABSTRACT FROM AUTHOR]

Respect for autonomy is an important moral principle within medical ethics. However, the question of whether the normative importance of respect for autonomy is derived from other moral principles (such as welfare) or has independent moral value is debatable. In this paper it is argued that the normative importance of autonomy is derived from both welfare and non-welfare considerations. Welfare considerations provide two types of reason to respect autonomy, one related to the role of autonomy in creating welfare and one related to its role in constituting welfare. In addition, autonomy seems to have normative importance that is unrelated to welfare considerations. This type of normative role is difficult to defend within medical ethics, because most non-welfare justifications of autonomy work for only a proportion of the autonomous decisions that patients make and give no clear guidance on how to respond to autonomous yet welfare-reducing treatment requests. A recent account of autonomy (Stephen Darwall's "demand" account) provides a nuanced defence of autonomy that does not rely on welfare considerations. Darwall's approach seems to work well within medical ethics and provides a principled explanation of how to respond to autonomous patient requests for treatment options that may not be in their best medical interests. It is argued that to fully respect autonomy within a medical consultation, practitioners must consider non-welfare autonomy as well as instrumental and intrinsic welfare-related autonomy. [ABSTRACT FROM AUTHOR]

A recurrent issue in the vast amount of literature on reasoning models in ethics is the role and nature of moral intuitions. In this paper, we start from the view that people who work and live in a certain moral practice usually possess specific moral wisdom. If we manage to incorporate their moral intuitions in ethical reasoning, we can arrive at judgements and (modest) theories that grasp a moral experience that generally cannot be found outside the practice. Reflective equilibrium (RE) provides a framework for balancing moral intuitions, ethical principles and general theories. Nevertheless, persisting problems associated with the use of intuitions need to be addressed. One is the objection that moral intuitions lack the credibility necessary to guide moral reasoning. Ethicists have tried to solve this problem by formulating criteria to separate the "bad" intuitions from the "good" ones at the beginning of the reasoning process. We call this the credible input-justified outcome strategy. An example is the appeal to the common morality by Beauchamp and Childress. We think this approach is unsuccessful. As an alternative, we outline the good reasoning-justified outcome strategy. It connects to a variant of RE in which intuitions from different sources are incorporated. We argue that the elements of RE have different levels of justificatory power at the start of reasoning. In our strategy, each element can gain or lose justificatory power when it is tested in a reasoning process that meets several criteria. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the associations among cigarette design features and tar yields of leading cigarette brands sold in the United States, Canada, Australia and the United Kingdom. METHODS: Government reports and numbers listed on packs were used to obtain data on International Organization for Standardization (ISO)/Federal Trade Commission (FTC) yields for the tar of 172 cigarette varieties sold in the United States, Canada, Australia and the United Kingdom. We used standardised methods to measure the following 11 cigarette design parameters: filter ventilation, cigarette pressure drop, filter pressure drop, tobacco rod length, filter length, cigarette diameter, tipping paper length, tobacco weight, filter weight, rod density and filter density. RESULTS: Filter ventilation was found to be the predominant design feature accounting for the variations between brands in ISO/FTC tar yields in each of the four countries. After accounting for filter ventilation, design parameters such as overwrap length, tobacco weight and rod density played comparatively minor roles in determining tar yields. CONCLUSIONS: Variation in ISO/FTC tar yields are predicted by a limited set of cigarette design features, especially filter ventilation, suggesting that governments should consider mandatory disclosure of cigarette design parameters as part of comprehensive tobacco product regulations. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

When, as a condition of the Master Settlement Agreement (MSA) in 1998, US tobacco companies disbanded the Council for Tobacco Research and the Center for Indoor Air Research, they lost a vital connection to scientists in academia and the private sector. The aim of this paper was to investigate two new research projects funded by US tobacco companies by analysis of internal tobacco industry documents now available at the University of California San Francisco (San Francisco, California, USA) Legacy tobacco documents library, other websites and the open scientific literature. Since the MSA, individual US tobacco companies have replaced their industrywide collaborative granting organisations with new, individual research programmes. Philip Morris has funded a directed research project through the non-profit Life Sciences Research Office, and British American Tobacco and its US subsidiary Brown and Williamson have funded the non-profit Institute for Science and Health. Both of these organisations have downplayed or concealed their true level of involvement with the tobacco industry. Both organisations have key members with significant and long-standing financial relationships with the tobacco industry. Regulatory officials and policy makers need to be aware that the studies these groups publish may not be as independent as they seem. [ABSTRACT FROM AUTHOR]

African American distrust of medicine has consequences for treatment seeking and healthcare behaviour. Much work has been done to examine acute events (eg, Tuskegee Syphilis Study) that have contributed to this phenomenon and a sophisticated bioethics discipline keeps watch on current practices by medicine. But physicians and clinicians are not the only actors in the medical arena, particularly when it comes to health beliefs and distrust of medicine. The purpose of this paper is to call attention not just to ethical shortcomings of the past, but to the structural contexts of those events and the contributions and responsibilities of popular media and academic disciplines in the production of (often mythic) knowledge. We argue that ignoring context and producing inaccurate work has real impacts on health and healthcare, particularly for African Americans, and thus engenders ethical obligations incumbent on disciplines traditionally recognised as purely academic. [ABSTRACT FROM AUTHOR]

Objective: Trial testimony from the United States provides a unique opportunity to examine strategies of the American tobacco industry. This paper examines congruence between the arguments for tobacco control policy presented by representatives of the American tobacco industry at trial and the stages of responsibility associated with corporate social responsibility principles in other industries. Data sources: Trial testimony collected and coded by the Deposition and Trial Testimony Archive (DATTA). Study selection: All available testimony was gathered from representative senior staff from major tobacco companies: Brown & Williamson, Philip Morris, RJ Reynolds, and Liggett. Data extraction: Transcripts from each witness selected were collected and imported in text format into WinMax, a qualitative data program. The documents were searched for terms relating to tobacco control policies, and relevant terms were extracted. A hand search of the documents was also conducted by reading through the testimony. Inferred responsibility for various tobacco control policies (health information, second-hand smoking, youth smoking) was coded. Data synthesis: The level of responsibility for tobacco control policy varied according to the maturity of the issue. For emerging issues, US tobacco company representatives expressed defensiveness while, for more mature issues, such as youth smoking, they showed increased willingness to deal with the issue. This response to social issues is consistent with corporate social responsibility strategies in other industries. Conclusion: While other industries use corporate social responsibility programmes to address social issues to protect their core business product, the fundamental social issue with tobacco is the product itself. As such, the corporate nature of tobacco companies is a structural obstacle to reducing harm caused by tobacco use. [ABSTRACT FROM AUTHOR]

This paper reviews the tobacco industry's litigation strategy for addressing the addiction issue through trial testimony by its experts, and opening and closing statements by its lawyers. Despite the fact that several companies now claim to accept, in varying degrees, the conclusions of the Surgeon General concerning tobacco addiction, the tobacco industry litigation strategy pertaining to addiction is essentially unchanged since that of the early 1980s when the issue emerged as crucial. The industry uses its experts and the process of cross-examination of plaintiff's experts to imply that the addictiveness of tobacco and nicotine are more comparable to substances such as caffeine, chocolate, and even milk, than to heroin, cocaine and alcohol. Furthermore, the tobacco industry contends that the definition of addiction has now become so broadened as to include carrots and caffeine and hence that any concurrence that smoking is addictive, does not imply that cigarettes are addictive to the standards that drugs such as heroin and cocaine are addictive. Finally, the industry has continuously asserted that tobacco users assumed the risks of tobacco since they understood that quilting could be difficult when they began to use, and moreover, that the main barrier to cessation is lack of desire or motivation to quit and not physical addiction. These positions have been maintained through the 2004-2005 US Government litigation that was ongoing as the time of this writing. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of litigation against the tobacco industry in the United States during the years 1994-2005 (described as the "third wave" of tobacco litigation). "Epidemiology" refers to the study of the distribution and determinants of disease in populations. We apply the term "epidemiology" to the litigation context for purposes of characterising qualitatively and, to the extent possible, quantitatively the variety of cases litigated against tobacco manufacturers and allied tobacco interests during the third wave and their impact on the tobacco industry. Methods: The data for this paper come from legal cases identified in the Tobacco Deposition and Trial Testimony Archive (DATTA) collection (http://tobaccodocuments.org/datta), transcripts of testimony and related documents found in DATTA, government-mandated reports filed by tobacco manufacturers with the US Securities and Exchange Commission, investment company reports, reports and analyses published by the news media, a variety of informational documents produced by the Tobacco Control Resource Center at the Northeastern University School of Law, and legal settlement documents provided by the National Association of Attorneys General. Results: The US tobacco industry faced a far greater number of lawsuits, and a greater variety of types of lawsuit, between 1994 and 2005 than it had in previous years. Plaintiffs won 31 (41%) of the 75 cases that were tried to verdict during the years 1995-2005. Seven plaintiffs have been paid awards totalling US$115 million, including interest, following the exhaustion of appeals. Based on an evaluation of litigation brought against US industry leader Philip Morris, the total number of cases pending peaked in 2000, dropping off modestly since then. For example, 36 class actions were pending in 2000, while 33 were pending in 2005. In the same time period, individual actions fell from a total of 3385 to 2863. While the playing field has been levelled to some degree in the tobacco litigation arena with respect to the resources brought to bear by plaintiffs and defendants, tobacco industry defendants continue to employ far greater financial and human resources than their adversaries. Conclusions: The third wave of tobacco litigation has represented a sea change in efforts to hold the tobacco industry in the United States accountable in American courtrooms. While tobacco manufacturers continue to do their utmost to make these cases difficult to pursue, many of the cases that have gone to trial have met with success in recent years, which suggests that plaintiffs' lawyers are now better equipped to persuade juries of the defendants' culpability. [ABSTRACT FROM AUTHOR]

The capacity-building strategy used by a U.S.-based research organization, the Pacific Institute for Research and Evaluation (PIRE), to strengthen the system for the protection of human research subjects and the infrastructure of its international collaborating partner, the University of Liberia, are discussed. To conduct the much-needed biomedical and social science-based research-related activities in the future, this partnership is expected by PIRE to gradually evolve over time to strengthen the capacity of the local investigators and administrators of the University of Liberia. Accordingly, a unique opportunity to share technology and resources with a post-conflict, resource-constrained country is created by this partnership. This capacity-building model to strengthen the protection of human subjects in research can also be replicated in similar resource-constrained international settings and, accordingly, our experiences and limitations are shared in this paper. [ABSTRACT FROM AUTHOR]

Psychoactive drugs are being prescribed to millions of Americans at an increasing rate. In many cases these drugs are necessary in order to overcome debilitating emotional problems. Yet in other instances, these drugs are used to supplant, not supplement, interpersonal therapy. The process of overcoming emotional obstacles by introspection and the attainment of self knowledge is gradually being eroded via the gratuitous use at psychoactive medication in order to rapidly attain a release from the common problems that life inevitably presents us with. In this paper, I argue that Kant's formula of humanity, which maintains that persons ought never to treat others or themselves soley as a means to an end, proscribes this. Moreover, Kant argues that we have an imperfect duty of self development, and I argue that we fail to adhere to such a duty whenever we seek to evade the process of introspection and self knowledge in favour of the expedient results that drugs may provide us with as we attempt to overcome the emotional hurdles in our lives. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This paper describes a new surveillance system called the National Violent Death Reporting System (NVDRS), initiated by the United States Centers for Disease Control and Prevention. NVDRS's mission is the collection of detailed, timely information on all violent deaths. DESIGN: NVDRS is a population based, active surveillance system designed to obtain a complete census of all resident and occurrent violent deaths. Each state collects information on its own deaths from death certificates, medical examiner/coroner files, law enforcement records, and crime laboratories. Deaths occurring in the same incident are linked. Over 270 data elements can be collected on each incident. SETTING: The 13 state health departments of Alaska, Colorado, Georgia, Maryland, Massachusetts, New Jersey, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin. SUBJECTS: Cases consist of violent deaths from suicide, homicide, undetermined intent, legal intervention, and unintentional firearm injury. Information is collected on suspects as well as victims. INTERVENTIONS: None. OUTCOME MEASURES: The quality of surveillance will be measured in terms of its acceptability, accuracy, sensitivity, timeliness, utility, and cost. RESULTS: The system has just been started. There are no results as yet. CONCLUSIONS: NVDRS has achieved enough support to begin data collection efforts in selected states. This system will need to overcome the significant barriers to such a large data collection effort. Its success depends on the use of its data to inform and assess violence prevention efforts. If successful, it will open a new chapter in the use of empirical information to guide public policy around violence in the United States. [ABSTRACT FROM AUTHOR]

Background: A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine. Methods: A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0-100%. Main outcome measures: Changes in years of potential life before age 85 (YPL85). Results: If nicotine accounts for less than a third of smokers' excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals. Conclusions: Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy. INSET: What this paper ads.. [ABSTRACT FROM AUTHOR]

Describes the experience of uninsured and Medicaid Oregon tobacco users who registered in Free and Clear, a telephone based cessation program. Seven day quit rate; Use of nicotine patches or gum; Causality regarding the relationship between number of calls completed and quit rates. INSET: What this paper adds..

This paper provides a brief overview of the history of Massachusetts' opposition to smoking. It describes the current Massachusetts Tobacco Control Program and its smoking intervention programmes; changes in public opinion, perceptions and attitudes toward smoking; and programme impact. Massachusetts has been successful in developing a comprehensive intervention that has had encouraging results in changing public attitudes about smoking and in helping smokers to quit. [ABSTRACT FROM AUTHOR]

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. [ABSTRACT FROM AUTHOR]

Objective-To assess the print media coverage of California's smokefree bar law in Ja Le state of California. Design-Content analysis of newspaper, trade journal, and magazine items. Subjects-Items regarding the smokefree bar law published seven months before ai rid one year following the implementation of the smokefree bar law (June 1997 to December 1998). Items consisted of news articles (n= 446), opinion editorials n = 31), editorials (n = 104), letters to the editor (n = 240), and cartoons (n = 10). Main outcome measures-Number and timing of publication of items, presence of tobacco industry arguments or public health arguments regarding law, positive, regarding, and neutral views of opinion items published. Results-53% of items published concerning the smokefree bar law were news articles, 47% were opinion items. 45% of items regarding the smokefree bar law were published during the first month of implementation. The tobacco industry dominated coverage in most categories (economics, choice, enforcement, ventilation, legislation, individual quotes), except for categories public health used the most frequently (government role, tactics, organisational quotes). Anti-law editorials and letters to the editor were published more than pro-law editorials and letters. Region of the state, paper size, presence of local clean indoor air legislation, and voting on tobacco related ballot initiatives did not have an impact on the presence of opinion items. Conclusions-The tobacco industry succeeded in obtaining more coverage of the smokefree bar law, both in news items and opinion items. The tobacco industry used historical arguments of restricting freedom of choice and economic ramifications in fighting the smokefree bar law, while public health groups focused on the worker protection issue, and exposed tobacco industry tactics. Despite the skewed coverage, public health groups obtained adequate attention to their arguments to keep the law in effect. [ABSTRACT FROM AUTHOR]

Many children in the USA are prescribed psychotropic drugs that have not been fully investigated in paediatric clinical trials. The common practice of prescribing psychotropic drugs off-label poses unknown and potentially serious short- and long-term consequences for these children. This paper briefly reviews the factors associated with the lack of paediatric clinical trials. We advocate a shift toward increasing paediatric trials with psychotropic drugs through a combination of adequate safety controls, additional reimbursement/compensation, a more organised and large-scale effort to collate results and outcomes across researchers and studies and additional public education about the importance of this research. In addition, we encourage the re-examination of the ethical standards for children's participation in phase 1 clinical trials as well as argue for longitudinal developmental studies on children who are prescribed off-label psychotropic drugs. [ABSTRACT FROM AUTHOR]

Principlism aims to provide a framework to help those working in medicine both to identify moral problems and to make decisions about what to do. For it to meet this aim, the principles included within it must express values that all morally serious people share (or ought to share), and there must be no other values that all morally serious people share (or ought to share). This paper challenges the latter of these claims. I will argue that as a descriptive claim about what values morally serious people do in fact share, principlism is inadequate; more principles would be needed to make this claim true. Furthermore, I will argue that while, taken as a claim about what principles we ought to share, principlism could turn out to be correct, it is either unsupported or unable to meet its aims. The only way in which principlists can avoid these problems is to add to the current four principles. [ABSTRACT FROM AUTHOR]

Reports developments related to medicine in the United States. Aspects of immunization against smallpox, cholera and yellow fever; Introduction of thrombosis research unit; Role of Royal Society of Medicine in providing a prize for the best paper in medicine.

The article discusses that after screening for breast or colorectal cancer, what is the time lag needed before cancer deaths are seen. According to a research paper by Sei J Lee and colleagues, cancer screening does help in preventing cancer deaths in the future, the time to benefit from is unclear. The paper adds that the screening prevents one cancer death per 1000 patients screened at 10 years, and it should be carried out on patients who have a life expectancy of more than 10 years.

The patient-doctor relationship has recently come under intense scrutiny, resulting in a re-evaluation of the basis of that relationship. The papers by Glannon and Ross, and McKay seek to identify the sources of authority in the patient-doctor relationship by evaluating it in terms of the concept of altruism. In this paper I argue that the analysis of Glannon and Ross, and of McKay is unnecessary and that the analysis offered by the latter is also flawed. I do acknowledge, however, that Glannon and Ross's description of doctors' responsibilities and patients' roles has much to commend it. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a paper which investigated the changes in mortality in the U.S. during the Great Depression, published in a previous issue of the "Journal of Epidemiology and Community Health."

This article presents updates related to medical ethics. It announces that the British government that it would phase in the of the Mental Capacity Act 2005 for England and Wales. The British in December 2006 published a white paper entitled "Review of the Human Fertilization and Embryology Act," to seek for the revision of legislation on human reproductive technologies. The sterilization case of Ashley, a severely mentally disable children in the U.S., has ignited medical ethics debate.

Reports the National Drug Abuse Conference on May 5 to 9, 1977 in San Francisco, California. Main topic of the conference; Presentation of papers dealing with racial politics; Discussion of non-traditional healing.

Background and Objectives In the US, Hispanic mothers have rates of infant mortality and low birthweight that are comparable to non-Hispanic White mothers despite being more likely to live in socio-economically deprived areas. This well known phenomenon is termed the Hispanic paradox. Recent research suggests that this phenomenon may be partly explained by the areas in which Hispanic people live. Hispanic mothers living in counties with a high proportion of Hispanic people (Hispanic density) have lower rates of infant mortality and smoking during pregnancy. In this paper, we investigate whether or not Hispanic density is associated with better birth outcomes for mothers of other ethnicities. Design Multilevel analysis of the US Linked Birth and Infant Death Dataset 2000 and US census data at county level. Setting USA. Participants 2 274 247 White and 581 151 Black non-Hispanic mothers of singleton births. Main outcome measures Infant mortality, low birthweight, preterm delivery and maternal smoking during pregnancy. Results Living in counties with a higher percentage of Hispanic residents was associated with reduced risk of all outcomes for non-Hispanic White and Black mothers and infants in analyses adjusting for individual and area level socio-demographic characteristics. The reduction in odds was greatest for maternal smoking during pregnancy. White mothers living in counties where more than half the residents were Hispanic had their odds of smoking during pregnancy reduced by approximately 80% (OR 0.19 95% CI 0.11 to 0.33), relative to comparable mothers living at Hispanic densities of 0 to 1%. Similar reductions in risk of maternal smoking during pregnancy were found for Black mothers (OR 0.14 95% CI 0.14 to 0.51). Infant mortality was reduced by approximately a third for both Black and White mothers living in counties with a high proportion of Hispanic residents. In addition, higher Hispanic density was associated with modest but significant reductions in the risks of preterm delivery and low birthweight. Conclusions Living in Hispanic communities appears to have health benefits for those of non-Hispanic origin. [ABSTRACT FROM PUBLISHER]

In 2006, a paper in the journal Archives of Pediatric and Adolescent Medicine described a novel case of growth attenuation therapy and other treatments carried out on Ashley, a severely cognitively, neurologically and physically disabled 6-year-old girl. Some of the moral arguments that have sprung up in respect of the so-called "Ashley treatment" are considered, and it is suggested that they all miss something—that the proper treatment of Ashley may have as much to do with doctors' duties to themselves as with their duties to her. It is suggested that the Ashley treatment may have been in violation of doctors' self-regarding duties and that this possibility is worthy of further investigation. [ABSTRACT FROM AUTHOR]

This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss "objectionable" options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise. [ABSTRACT FROM AUTHOR]

Presents several views on medicine. Outbreak of rheumatic fever among children in the United States; Quality of paper used in medical journals; Techniques of the Heimlich maneuver used in choking victims.